| NPI | 1205884335 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 218371) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 01506) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-12-17 |